On Jan. 23, 2023, JamieLynn and AmieLynn made history as the first conjoined twins to be surgically separated at Cook Children’s. The girls were conjoined at the chest and shared a liver. Their 11-hour surgery involving a team of 25 medical professionals, including six surgeons, made headlines around the world. The girls were being cared for at Cook Children’s Neonatal Intensive Care Unit (NICU) since birth. Last week, AmieLynn was discharged and both girls are living with their family in Fort Worth.

Their parents, James and Amanda, attended the meeting Tuesday, all smiles as they held Jamie and Amie in their arms.

The proclamations read:

Proclamation - JamieLynn and AmieLynn Finley Day

Whereas, when parents James Finley and Amanda Arciniega of Saginaw found out they were expecting twins, they were surprised; then a short time later that surprise turned into worry when they learned their babies were conjoined; and

Whereas, while Mother-to-Be, Amanda, enjoyed an easy and uncomplicated pregnancy, there were many hours spent meeting with specialists from across the state to determine who was best to deliver the Finley Twins and the best hospital to care for them after birth; both of which ended up being right up the road and

Whereas, on October 3, 2022, at 34 weeks gestation JamieLynn and AmieLynn were delivered via C-section at Texas Health Fort Worth. After a monthlong stay at the Texas Health NICU, the girls were transferred to Cook Children’s Medical Center NICU; and 

Whereas, after months of planning and collaboration, which included building the medical team, troubleshooting potential issues and rehearsing the carefully choreographed surgical production; the medical team determined when the girls reached 4 months old, it was right time to separate them; and

Whereas, on January 23, 2023, after an 11-hour surgery, with a team of 25 medical professionals, including 6 surgeons, Cook Children’s Medical Center successfully performed its first-ever separation surgery on 16-week-old conjoined twins, JamieLynn and AmieLynn.

Now, therefore, be it resolved, that we, the Commissioners Court of Tarrant County, do hereby proclaim January 23, 2023, as JamieLynn and AmieLynn Finley Day in honor of their successful separation surgery. 

In witness whereof, we have hereunto set our hands and caused the Seal of Tarrant County to be affixed this 18th day of April 2023.

Congratulatory Resolution - Cook Children's Medical Center

Whereas, located in the heart of Fort Worth’s Medical District, Texas Health Harris Methodist Hospital and Cook Children’s Medical Center share a long history of collaboration; and 

Whereas, both organizations have a close working relationship bonded through the common goal of putting family first while providing advanced medical treatments with heartfelt compassion to families in need throughout Tarrant County and across the State of Texas; and 

Whereas, the nationally recognized neonatologists, pediatricians, specialists, researchers, and clinicians of Cook Children’s Medical Center’s NICU are specially trained in the complexities of critically ill newborns and babies born prematurely; and 

Whereas, the Doctors, Nurses & Staff inside of Cook Children’s Medical Center & the Level IV NICU tirelessly work around the clock, every single day of the year to provide critical care for the most difficult and complex medical diagnosis, including the tiniest, micro preemies born as early as 23 weeks and weighing as little as one pound; and 

Whereas, on Monday, 23rd of January, a remarkable team of 25 medical professionals and 6 surgeons performed a groundbreaking 11-hour surgery to separate conjoined twin sisters, AmieLynn Rose Finley and JamieLynn Rae Finley of Fort Worth, Texas. 

Whereas, the incredible team assembled by Cook Children’s Medical Center and their collective expertise in treating the most difficult, rare and complex pediatric conditions, made this challenging procedure successful and the Finley family whole again; and 

Whereas, the citizens of Tarrant County recognize the critical need for the Neonatology Team at Cook’s Children’s Medical Center who are committed to the care and well-being of North Texas families; and 

Now therefore, be it resolved, that we, the Commissioners Court of Tarrant County, do hereby honor and congratulate the teams of nursing & medical professionals at Cook Children’s Medical Center and the NICU on their continued efforts in our community. In witness whereof, we have hereunder set our hands and caused the Seal of Tarrant County to be affixed this 18th day of April, 2023.

José L. Iglesias, M.D., FACS, Medical Director of Pediatric Surgery at Cook Children’s Medical Center, who was the lead surgeon during Cook Children's first separation of conjoined twins, was featured on the cover - “Inside Cook Children's Miraculous Separation of Conjoined Twins.”

Dr. Iglesias, Ben Gbulie, M.D., plastic surgeon; Chandra Reynolds, M.D., lead anesthesiologist; Marty Knott, D.O., primary surgeon; Mary Fran Lynch, M.D., neonatologist; and Chad Barber, M.D., neonatologist were featured in the nine-page spread. This issue is available on newsstands now.

Fort Worth Magazine: “It’s rare as it is, being born as conjoined twins. And to survive as long as they have, even rarer. But to separate via a historic procedure at Cook Children’s Medical Center makes the lives of AmieLynn and JamieLynn Finley a miracle.”

Read the full story here.

By Eline Wiggins

Formerly-conjoined twin AmieLynn Finley went home on Friday for the first time to join her twin sister JamieLynn, parents and the rest of her family.

In January, JamieLynn and AmieLynn made history as the first conjoined twins to be surgically separated at Cook Children’s. The girls were conjoined at the chest and shared a liver. Their 11-hour surgery involving a team of 25 medical professionals, including six surgeons, made headlines around the world.

Amie, the quiet twin compared to feisty JamieLynn, has made huge progress even though her journey has been more difficult. While JamieLynn went home on March 21, Amie stayed at the Cook Children’s Neonatal Intensive Care Unit (NICU) to recover from a recent surgery to improve her chest incision and create more space for her heart, diaphragm and lungs.

On April 7, Amie left the hospital in a car seat with her parents, Amanda and James Finley, JamieLynn, two older siblings and cousin. The family shared hugs and tears with the girls’ care team as they loaded their stuff for the last time in their minivan. Today, the whole family is together, in their own home, at last.

“This is kind of the beginning again,” James said as he cradled JamieLynn. “Surgery was one beginning and now we’re going home to another beginning.”

“It’s definitely a weight lifted,” Amanda said. “I’m excited and happy, it’s a lot of emotions. We still have a long way to go.”

Both girls will have some work to do, including rehabilitation, to help them reach their full potential. When the twins were conjoined, Amie developed scoliosis as she had a natural inclination to lean back and pull away from JamieLynn. The girls’ care team hope they will grow up healthy, happy and independent young ladies with their amazing family.

“It is a blessing to watch the girls heal through a major operation, and see the various milestones such as being weaned off of their ventilators, then oxygen; watch as their intestines start to tolerate increasing feeds and then watch as they learn to feed orally,” said José Iglesias, M.D., FACS, Medical Director and Lead Surgeon at Cook Children’s.

“Both girls are so tough!” said Brianne Galvan, RN, the girls' nurse in the NICU. “They went through some pretty tough times but came out smiling in the end. It was amazing for me to see their resilience and to be a part of their story! I will miss their sweet faces and smiles tremendously!”

Amanda and James have spent a lot of time at the NICU since the girls were transferred there shortly after they were born in October. At their Fort Worth home, the girls will finally share the same room again.

“I’m so excited for the girls to be able to assimilate into their new home with their entire family 24 hours a day. My wish for them is that they get to experience all of the normal joys of family life that they haven’t been able to experience in the hospital,” said Neonatologist Fran Lynch, M.D. “These girls are truly remarkable and I can’t wait to see what they accomplish in their lives moving forward.”

Conjoined twins are estimated to occur in only 1-in-200,000 live births. JamieLynn and AmieLynn are omphalopagus twins, meaning they were joined at the abdomen and shared one or more internal organs.

“With so many steps in their journey it reminds us how big and how great our Cook’s Children’s family is to help them achieve milestone after milestone,” Iglesias said. “I’m proud of the loving and attentive family and proud of an amazing team is probably the best summary I have.”

For those wishing to assist the Finley family in this new chapter of their lives, a fund has been created at EECU in Fort Worth. The family also has a baby registry at Walmart.

RELATED STORIES:

Formerly-Conjoined Twin JamieLynn Discharged from Cook Children's NICU, Sister AmieLynn Stays to Recover (checkupnewsroom.com)

‘We Did It’: Conjoined Twin Girls Separated at Cook Children’s Medical Center Make History (checkupnewsroom.com)

Q&A: Inside the Historic Conjoined Twin Separation Surgery with Jose Iglesias, M.D. (checkupnewsroom.com)

By Eline Wiggins

Five-month-old JamieLynn Finley is home in her own bed for the first time in her life. 

In January, JamieLynn and AmieLynn made history as the first conjoined twins to be surgically separated at Cook Children’s. The girls were conjoined at the chest and shared a liver. Their 11-hour surgery involving a team of 25 medical professionals, including six surgeons, made headlines around the world.

On Tuesday, March 21, Jamie was discharged from Cook Children’s Neonatal Intensive Care Unit (NICU), nearly two months to the day of her separation. She left the hospital in a car seat with her parents, Amanda and James Finley, and Jamie’s three older siblings. It is a big day for the Finley family.

“We’ve been looking forward to this for a long time,” said the girls’ doctor, Mary Frances Lynch, M.D., neonatologist at Cook Children’s.

While Jamie is starting her new chapter at home, Amie is staying in Cook Children’s NICU for at least a few more weeks. Amie’s journey has been more difficult and she is continuing to recover from a recent surgery that improved her chest incision and created more space for her heart, diaphragm and lungs.

“There were some moments that were scary,” James said.

The twins will be away from each other until Amie can head home, which is expected to happen within a month or so. Jamie has recovered so well since the separation surgery, she’s currently bouncing and babbling to anyone who will listen. She’s going home with a gastrostomy tube (G-tube) to help with her feeding and continued growth. However, by all indications, she’s on her way to being a healthy and happy child.

“We’re excited that we get to get her home,” James said. “We’ll have some good bonding time, but at the same time, Amie is still up there so it’s kind of a double-edged sword. We’re happy Jamie is coming home, but they’re not going to be together for a bit.”

On Tuesday morning, Jamie and Amie laid side-by-side and took a ride in their red wagon as their mom Amanda pulled them down the NICU hallways.

“Hi, sugar pudding,” James smiled and said to the girls. 

The girls are growing up fast and hitting their milestones. Jamie is about to start rolling over, Amanda said. Amie says “hello” and both girls do their best to talk.

Amanda joked that Jamie will miss all the attention she gets from the nurses and health care workers in the NICU.

At home, Amanda is excited to hold the girls in their new rocking chair. The girls have many new friends waiting to meet them too, including Amanda and James’ neighbors.

Between their three older siblings, family and neighbors, the girls will be showered with lots of love inside their own home and in their new nursery.

“Everybody is ready to see them,” James said.

RELATED STORIES:

‘We Did It’: Conjoined Twin Girls Separated at Cook Children’s Medical Center Make History (checkupnewsroom.com)

Q&A: Inside the Historic Conjoined Twin Separation Surgery with Jose Iglesias, M.D. (checkupnewsroom.com)

The Surgical Team that Made History at Cook Children's (checkupnewsroom.com)

As the Surgeon-in-Chief for Cook Children’s Healthcare System, Eric Hubli, M.D. knows that every surgery needs a backup plan. In many cases, one backup plan is not enough.

“The key to a really good surgeon is the ability to adapt. When operations move in a unique or unexpected direction, you have to be able to create plans b, c, d and e,” Dr. Hubli said.

During the separation procedure for 16-week-old conjoined twins AmieLynn and JamieLynn Finley, multiple layers of plans were considered and vetted in order to give the girls a chance at life on their own. Dr. Hubli has been a colleague and champion for surgeons at Cook Children’s for the past 15 years. Now he is part of a multispecialty team that came together in an effort to understand and manage every nuance of the separation surgery.

Dr. Hubli’s primary role before the surgery was to assist the other surgeons with the organizational process to remove any barriers so their vision could be realized.

“We put our minds together, reviewed all the clinical data and thought about where the challenges would be," Dr. Hubli said. "We then worked to solve them. One person cannot figure it all out, so it was truly a blessing that we had surgeons, anesthesiologists and multiple doctors from different backgrounds. The various viewpoints allowed us to see things from many angles and these collegial interactions were critical to our future success. There were no egos for we were all focused on one goal – a safe and successful surgery.”

Journey to Plastic Surgery

When Dr. Hubli started medical school at Tufts University School of Medicine, he planned to become a pediatrician, but one surgery changed everything.

“During my first clinical rotation, I saw an operation for the first time in my life," Dr. Hubli said. "It was the coolest thing that I had ever seen. The patient went to sleep and woke up ‘fixed.’ I thought the procedure was nothing short of miraculous so right then and there, I decided that I was going to be a surgeon. There are many surgical fields, but I decided on pediatric craniofacial/cleft and plastic surgery because I love working with kids and I enjoy the challenge associated with the uniqueness of every surgery. No two cases are alike, so every operation requires its own unique solution.”

As medical director of Craniofacial and Cleft Services at Cook Children’s, Dr. Hubli brings more than 29 years of craniofacial, cleft and pediatric plastic surgery experience. His focus is exclusively on children with reconstructive craniofacial and cleft issues.

“One of the things I love about pediatric craniofacial surgery is that I get to be with my patients throughout their childhood and teenage years," Dr. Hubli said. "I meet them as a baby and then travel along with them as they grow and develop. Facial structures change as we grow so I monitor my patients and make surgical adjustments when needed. I have two kids of my own, but I consider all these patients to be mine as well.”

Giving the Twins a New Lease on Life

Early on January 23, Dr. Hubli felt more than ready. Gathered outside the Operating Room doors, he joined the twins’ team of 25 medical staff as the group took a moment to pray for the long day ahead. All the hours of planning and replaying different scenarios in their minds would play out in real life.

Once they walked through the Operating Room doors, Dr. Hubli was confident that each team member knew their role and that the group was up to the challenge ahead. He wore green scrubs along with AmieLynn’s team and worked with the pediatric surgeons to perform her closure after the separation. Dr. Hubli said mental nimbleness is an essential part of the surgery – something his team is very familiar with and practices every day. 

“In surgery, you have to expect the unexpected," Dr. Hubli said. "Even the most straightforward case may have a surprise.  On top of that, surgeons who practice in the pediatric realm face the unique challenge of changing patient size. One day you may be operating on a premature baby who weighs less than three pounds and the next day a 300-pound, 16-year-old offensive lineman from the local high school’s football team may be on your OR table. You have to be able to adjust.”

This ability to adjust is demonstrated by all those who participated in this unique surgery. Surgeons, anesthesiologists, scrub techs, nurses, CRNAs, administrators; every member of the Cook Children’s team understands these challenges and each one is uniquely prepared to rise to the occasion.

Milestones Lead to Historic Moment

Many milestones brought Cook Children’s to this historic moment of separating conjoined twins.

“When I think of the milestones of our surgery program, I think more about our milestones as a medical center because we are all connected to accomplish the same goal," Dr. Hubli said. "In my mind, that is what makes Cook Children’s unique. Across the board, from the police officers to the food services and environmental services employees to the Radiology department, from the lab technicians to the CEO and CFO – everyone is all in. The Cook Children’s family has a vocational dedication to caring for these kids and their families. Every person pulls in the same direction – we are here for the kids and their families. This laser focus is why the hospital and our surgery department are top-notch. I have worked in other facilities but Cook Children’s is special – going that extra step is our standard. The caring and kindness you feel at this hospital is genuine. Every patient and family really matters to our staff.”

With every year that passes, Cook Children’s attracts new highly talented people. Dr. Hubli said over the span of 15 years since he began at the hospital, the main campus has expanded from one building to a destination hospital system that covers eight city blocks. New Operating Rooms, new patient rooms, a new NICU and advanced medical devices were brought to Cook Children’s. A new medical center in Prosper opened this month.

“I’ve seen nothing but incredible growth. Every year we enhance our facilities and our staff. In turn, this means that our patients have access to more service lines and care options. The surgery department is a great example of this growth. In the past few years, every surgical service line has added new surgeons. These surgeons have different specialty training which broadens our ability to meet the needs of our community. If your child has a neurosurgical, orthopedic, urological, craniofacial/cleft, ENT, ophthalmologic, pediatric or cardiac surgery issue, we have the staff to assist. In fact, the breadth of the surgery program at Cook Children’s has been recognized by the American College of Surgeons and the medical center has been recognized as a Level One Children’s Surgery Center. This means the hospital rates as a high-end, full-service pediatric facility.” 

By the Numbers

• Surgeries performed at Cook Children’s every year – 20,000
• Sets of conjoined twins born viable in the world each year – 5 to 8
• Percentage of conjoined twins that are female – 70
• Hours spent planning separation surgery – hundreds
• Medical staff in OR for separation surgery – 25
• Total hours in Operating Room for separation surgery – 11
   

‘Every surgeon is potentiated by our wonderful staff'

Dr. Hubli said surgery involves much more than the surgeon. He firmly believes that surgery is a team sport. 

“It’s great to have the best surgeon in the world on your staff, but that surgeon is useless unless the rest of your hospital can meet the challenges presented by complex surgical care. I am happy to say that Cook Children’s has the required talent. From Central Supply to the PICU, from Environmental Services to the C suite, our team is ready, willing and able. This support allows every surgeon to maximize his/her talent as they are all potentiated by this wonderful staff.”

Looking beyond the clinical realm, Dr. Hubli points to the commitment and dedication of the Cook Children’s administration and the surrounding community as key factors in bringing the hospital to this point.

“We can do this case because of the talent we have in the building, the administrators we work with and the community that we serve who supports us unequivocally. I really feel the community is behind us in all we do. The care that we give to children and families when they come in is returned tenfold from the community we serve. Whether it’s time or treasure, the people of our community are 100% behind us. It’s this give and take that makes Cook Children’s great. And that’s why I think we continue to be very successful.”

“I am proud that we have grown to a point where we can meet the challenges presented by the most complex cases.  I am also proud that we have the team right here in Fort Worth. But it’s not personal pride – it’s pride in our team. I am humbled to work with a group of caring, dedicated and giving people. Our Promise speaks to caring for the children and families of our community. I am honored to be able to work with a group of people that bring Our Promise to life.”

It's Personal

Dr. Hubli knows what it feels like to hand over his child to a surgery team. Seven years ago, his son underwent surgery at Cook Children’s – an experience that changed his perspective. 

“I walked into the building that day as a parent, not a surgeon,” Dr. Hubli said. “Before my son’s surgery, I always used to see the clowns walking through the hall and didn’t think much of it. But then the clowns came to my son’s room, and it was the first time I saw him smile in two weeks. That event reminded me that every member of the Cook Children’s team contributes in their own special way. I love those guys.”

By Jean Yaeger

Marty Knott, D.O., Ph.D. was AmieLynn’s primary surgeon during the historic procedure to separate conjoined twins, AmieLynn and JamieLynn, on Jan. 23, 2023. Although this was his first time separating conjoined twins, Dr. Knott brought experience in operating on chest wall deformities, congenital malformations of the abdomen and chest, abdominal wall defects, tumors, bowels and vascular anomalies. He has worked at Cook Children’s for seven years.

Here are excerpts from a conversation with Dr. Knott prior to the twins’ separation.

It sounds like the area where these girls are joined is where you work quite a bit. Exactly. That's the interesting thing about it.  The actual surgery parts, if you break them down, are things that we do very commonly -- liver surgery and closing abdominal defects in newborn babies. So a lot of the techniques, skills and experience from other places can all be combined into this unique situation. The actual procedures themselves are pretty common.

How did you prepare specifically for this surgery? We have been meeting within our group but also with other subspecialties such as anesthesia and plastic surgery, as well as all of the different components of the operating room team, such as the certified scrub techs, OR nurses and anesthesia techs. It's one of those things where you have a huge team that comes together and everybody plays their role individually to make things happen. And then there's individual preparation by reviewing the scans and charts and the things that they've gone through so far, to just know what things might come up on that day.

Potentially what’s the biggest challenge? The liver separation part's going to be tedious. But the biggest issue is probably going to be getting their abdominal cavities closed and covered safely, because they do have a shared area from their lower sternum down to their belly button area that is open, meaning there's some separation of the muscle and the skin. Just finding effective ways to get that closed once the division has occurred is probably the most hard-to-predict part. For me that feels like the biggest unknown challenge. Everything else is relatively straightforward.

There are different techniques we use. We have babies that are born with other abdominal wall defects that aren't conjoined who still need some sort of either permanent or temporary closure. We'll use some of those techniques we use in other situations for them too. We’re just trying to figure out what's best and preparing for a variety of different options so that once we actually get them separated, we'll be able to know how best to close those abdominal wall defects or those openings so that the intestines, the liver and the heart are all covered safely.

While they're still conjoined, how does everyone who needs to be there fit around the table? There are a lot of people involved, and the table's not very big. To start with, it'll be Dr. Iglesias and I, and then we have two scrub techs that'll be scrubbed into the operation at the beginning. Our plastic surgeons are there as well. It'll be Dr. Iglesias and I until the babies are separated and then we form into two big full teams after that, one for Amie including Drs. Hamner and Hubli, one for Jamie including Drs. Lodwick and Gbulie.  That will be another set of at least four people around the table for each of us.

Someone steps up, someone steps back? Mostly like that, kind of scooting over and leaning. Most of the time we'll stay on our set sides. Typically, Dr. Iglesias will be on the right side and I will be on the left. We'll just work around that and figure out where everybody fits best.

Normally you operate on only one patient at a time and you can position that patient as needed. Can you speak a little bit about the fact that you may not be able to roll Amie the way you want her, because Jamie's there? They've lived most of the time on the sides where, if you're looking from their feet, Amie will be on the left and Jamie will be on the right. That's their baseline or most common position. So that's where we're going to have them during the surgery because that fits best for what they've tolerated so far. There are definitely some limitations. I always say this: In surgery, we try to use other experiences and techniques to fit into unusual situations. There are a lot of different surgeries where positioning has to change throughout the operation for us to be able to get it completed.

We're having to make some modifications within the surgery to where we can move them around a little and use different angles to get portions of the procedure completed safely. We'll use all of our experience and ideas from other situations that are more common to make that happen. But there are definitely some limitations in being able to do things as freely as we want to. Most of what we need to do while they're still joined will be pretty easy to do from the position that is most natural for them.

How long do you think it might take? Longer than expected, just with logistics of everything. Even though we've practiced multiple times, it'll be different on the real day. What I always tell parents when they ask: It'll take as long as it's necessary to get the thing completed safely. I have a timeline in my mind of how things are going to go, but I don't want to put it out there because it doesn't really matter. It's going to take as long as necessary to get them separated and keep them safe the whole time. We're planning for on an all-day event by the time everything's done.

What would you say to your colleagues at Cook Children’s?  This is one of those cool examples where everybody in the hospital gets to come together and participate. A lot of what we do gets kind of divided into little chunks where there's not much interaction between us. This has required a lot of coordination from NICU, to the nurses who know them well, the respiratory therapists, the anesthesiologists, the surgeons, the plastic surgeons and all our staff. Everybody's getting to play a pretty important role, and I hope that everybody sees the importance of what they do on a day-to-day basis.

Anything else? We're all looking forward to it and just asking for prayers that everything goes perfectly and that they recover well.

Jose L. Iglesias, M.D., Medical Director of Pediatric Surgery at Cook Children’s Medical Center, was the lead surgeon during the first separation of conjoined twins, JamieLynn and AmieLynn, in Cook Children's Medical Center's 105-year history.

During his 22 years at Cook Children’s Medical Center, Dr. Iglesias has been instrumental in the advancement of surgical procedures through the use of technology and minimally invasive surgery. He also specializes in chest wall deformities, congenital malformations of the abdomen and chest, vascular anomalies, tumors, gastrointestinal and genitourinary issues.

Here are excerpts from a conversation with Dr. Iglesias prior to the surgery to separate the twins on Jan. 23, 2023.

Did you always want to be a surgeon? My father was a surgeon, and when I was young, he would take me with him to observe patient rounds and surgeries. The thought of one day following in his footsteps was always a dream of mine. I thought working with my hands to help people was awesome. In my General Surgery training, I found my passion to care for the youngest of patients.

Tell me about the growth you have seen in the Cook Children’s Surgery program since your arrival in 2001. Here at Cook Children’s our footprint is constantly evolving. Since my arrival, we have made great strides in laparoscopy and thoracoscopy. Technology and the innovation of video and optics have allowed us to better care for all our patients, even the smallest ones. In addition, we have developed a robust Pectus Program offering the minimally invasive Nuss procedure to our patients with pectus excavatum.

An important part of our program here at Cook Children’s is Quality Improvement. To that end, I helped the hospital become part of the American College of Surgeons National Surgical Quality Improvement Program which measures and tracks the quality of our surgical procedures. This supports our goal to enhance surgical care and patient outcomes.

What is the most rewarding part of your job? For me, it’s the interactions and meaningful relationships that develop because somebody has trusted me with the care of their child. One specific instance involved a mother whose baby was born with a congenital anomaly that required surgical intervention. The mom was so touched by her experience that she ultimately applied for and became a nurse here at Cook Children’s. Another instance that I will never forget involved a young lady with a rare cancer diagnosis. I had the privilege of being her surgeon for several procedures and was involved in her care for over three years. Although she passed, the family invited me to her life celebration where I got to offer my heartfelt condolences to family members in person which meant so much to me. Knowing that I may have an impact on patients and families is both humbling and rewarding, and it is an honor that I will never take for granted.

When did you first meet the twins’ family? A longtime close colleague, and maternal fetal medicine physician, Dr. Bannie Tabor, reached out to me to tell me that he was following a mother with conjoined twins. Surprised by this once-in-a-lifetime phone call, I agreed to meet with mom and dad in our office prenatally. At that time, a fetal MRI showed favorable anatomy for separation.

How long did you plan for surgery to separate the twins? It was an eight-month planning process.

Did you choose the teams for the twins’ separation? Yes. I met with Dr. Chandra Reynolds, lead anesthesiologist, and Valerie Gibbs, director of Perioperative Services, and, together, we assembled the large team consisting of three anesthesiologists, four pediatric surgeons, two plastic surgeons and about a dozen additional OR staff professionals. 

How do you plan for a surgery like this? Months of preparation. Given the complexity of the operation, we held several team meetings and mock-up practice runs to formulate a solid plan knowing that we must prepare for unexpected challenges. We perform complex procedures frequently, but they don’t all have as big of a headline as this one.

What were the next steps? Imaging and growth. We obtained ultrasounds, CT scans, 3D reconstructions and met with radiologists to discuss the anatomy and the neonatologist to address the twins’ development. It was also important to allow the twins to grow to a reasonable size.

What are the plans for surgery? The operative plan involves a step-by-step outline of where to make the incisions in order to optimize the success of closure; we did this with the guidance of our plastic surgeons. Next, we will proceed through the abdominal wall and then on to the division of the liver and lower portion of their sternum, all of which the twins share. We will constantly be assessing any other abnormalities that need to be addressed. Imaging shows the intestines to be separate, but we are prepared for any surprises. Finally, options for abdominal and chest closure are addressed.

What happens once the babies are separated? Once separated, one twin will be transferred to a different bed where teams will split into their green and purple groups and continue operating until completion.

What are the significant risks associated with this surgery? The risks are significant for this type of procedure. Because we are dealing with two abdominal and chest cavities and several vital organs, our main concerns will be bleeding, infection and blood pressure changes. We will also monitor for any heart issues given that their hearts will be in a new position. Closing their abdomens will also be a significant challenge.

Tell me about James and Amanda, the parents of the twins. They are remarkable people. I am amazed by the strength that they have demonstrated throughout this overwhelming process.  They have been eager and willing to learn everything that has been presented to them.

How does it feel that they are entrusting you with their babies? It is always an honor and one that I do not take lightly, when a parent entrusts me with their most prized possession.

What does this surgery mean for you as a pediatric surgeon? The opportunity to separate conjoined twins is an exceptional privilege most pediatric surgeons never get. It is only because we are standing on the shoulders of giants who have trained us, and incredible leaders who have laid the groundwork for this extraordinary institution that we are able to fulfill our Promise.

What does this mean for Cook Children’s? In 105 years, Cook Children’s has never been presented with the opportunity to care for conjoined twins. This will forever be a part of our history, and it is a great honor to all of us that Amanda and James have entrusted us to provide care to AmieLynn and JamieLynn.

What do you anticipate the recovery will look like? The road to recovery will start off slowly. First, we want the large incisions to start healing and for their intestines to start working so that we may feed them. After feeds are started, we will have them work with both dieticians and speech therapists. As time progresses, the twins will likely need physical therapy to address musculoskeletal abnormalities. Other than that, the healthcare team will address any and all issues as they arise. Overall, we are hopeful for a smooth and successful recovery.

What do you think their prognoses will be after surgery? Given their anatomy, I am optimistic that they will recover well and lead happy and healthy lives.

How do you think you will feel once the surgery takes place? Proud of leading a great team to a successful twin separation and humbled by the family who entrusted us. We are a team that has worked countless hours individually, in small departmental groups, multidisciplinary, and now it is time to put all of those pieces together for an operation that will be monumental for all of us here at Cook Children’s Medical Center.

Lastly, I will forever be grateful. Grateful for AmieLynn, JamieLynn, Amanda, James, all of my friends, family and colleagues for supporting and encouraging me throughout this journey. 

Getting to know Dr. Iglesias

Dr. Iglesias is married with two kids. Practicing medicine runs in the family as his wife is a neonatologist, his son will graduate from medical school in June and his daughter is a nurse resident in the NICU at Cook Children’s. “I love having her there.”

Dr. Iglesias started scuba diving during college. His passion was passed onto his son and, together, they earned their master diver certifications. Once or twice a year, they explore new destinations together.

"I moved to Fort Worth and began my career as a Pediatric Surgeon at Cook Children's in 2001 after completing my training at St. Jude & Le Bonheur Children's in Memphis, TN. My wife and two children have loved growing with the city and the medical center ever since. I attended medical school at the University of Texas Southwestern and did my residency training there also, including Parkland and Dallas Children's hospitals. My clinical interests have included minimally invasive surgery, and I was fortunate to be able to expand the technology and procedures during my time at Cook Children's. Other clinical interests include pectus and chest wall deformities, tumors, vascular malformations, and congenital anomalies. Currently, I'm the Medical Director of Pediatric Surgery (since 2014) and previously was Associate Medical Director as well as the Chief of Surgery.

Outside of surgery, I enjoy spending time and traveling with my family. Photography, scuba diving, skiing and performance driving are among my favorite hobbies. My son and I are Master Divers who enjoy exploring new destinations while my daughter and I enjoy perfecting our photography skills with one another."